Blackburn, Ethan Wade
Blackburn, Ethan Wade is an individual health care provider with primary practice located at 315 E Broadway Ste 195 , Louisville KY 40202-3700. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Hand Surgery. Allopathic & Osteopathic Physicians / Hand Surgery is his primary health care specialty. Blackburn, Ethan Wade can be contacted via phone (502) 629-4263.Contact Information
Primary practice address
315 E Broadway Ste 195
Louisville KY 40202-3700
Phone: (502) 629-4263
Fax: (502) 629-4282
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 45826 | Kentucky |
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 01071401B | Indiana |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Hand Surgery | 207XS0106X | 45826 | Kentucky |
Profile Details
| NPI number | 1538387360 |
|---|---|
| LBN Legal business name | Blackburn, Ethan Wade |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 24th, 2007 |
| Last updated | Jan 12th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538387360 | NPPES |
| Kentucky | MEDICAID | 7100250140 | |
| Kentucky | Other | 000000833108 | |
| Kentucky | Other | 149325 | |
| Kentucky | Other | 50052189 |
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